Table 3

Indications for intracranial pressure (ICP) monitoring

Subarachnoid haemorrhageWith associated hydrocephalus–ventriculostomy allows therapeutic drainage and ICP monitoring
? patients in coma
? as a guide to hypertensive hypervolaemic treatment for delayed ischaemia
Spontaneous intracerebral haemorrhageThere is no good clinical evidence of benefit from monitoring patients in this group
Reye’s syndromeActive treatment of raised ICP decreases mortality
Blood ammonia >300 mg/100 ml and deteriorating conscious level usually considered indications for monitoring
Brain tumoursNot indicated routinely, but may be of value in selected patients deemed at high risk of swelling or obstructive hydrocephalus—for example, following posterior fossa surgery
Normal pressure hydrocephalusAn increase in spontaneous nocturnal “B” waves has been reported to be predictive of a good response to CSF diversion
Decompensated hydrocephalusCan be a valuable diagnostic tool in complex cases
“Benign” intracranial hypertensionMonitoring often undertaken via a lumbar subarachnoid catheter as both a diagnostic test and to monitor response to treatment
Other potential indicationsHypoxic brain swelling after drowning, meningitis, encephalitis, venous sinus thrombosis, and hepatic encephalopathy